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Assignment Questions

Regulation for
Nursing Practice Staff
Development Meeting

Objectives
 Describe the differences between a board of nursing and a

professional nurse association.
 Describe the geographic distribution, academic credentials,

practice positions, and licensure status of members of the
board for your specific region/area.

 Describe at least one federal regulation for healthcare.
 Describe at least one state regulation related to general

nurse scope of practice.
 Describe at least one state regulation related to Advanced

Practice Registered Nurses (APRNs).

Differences between a Board of Nursing
and a Professional Nurse Association

BOARD OF NURSING (BON)

 The board of nursing for each state is a
jurisdictional government agency. They are
responsible for the regulation of nursing
practice for each 50 sates.

 They are there to protect the public’s
health and welfare by overseeing and
ensuring the safe practice of nursing.

 They achieve this by outlining the
standards for safe nursing care and issuing
licenses to practice nursing.

 Once a license is issued, they continues by
monitoring licensees’ compliance to
jurisdictional laws and taking action against
the licenses of those nurses who have
exhibited unsafe nursing practice.

Professional Nurse Association

 Nursing organizations like the ANA and the National
League for Nursing (NLN) have a broad focus,
encompassing the entire nursing profession.

 There are more than 100 Nursing Organizations, like the
ANA.

 Unlike the BON, a nursing association (also called a
professional association) is a private organization whose
members must pay dues to enjoy the benefits of
membership. One of the primary functions of a nursing
association is to represent its members in legislative,
political, and practice matters. It provides a central voice
for its nurse membership

 A nursing association can lobby the legislature and
Governor for the interests of its members and the
profession of nursing. A nursing association provides a
united voice that can speak out on the issues important
to a specific area of nursing practice and/or to the
nursing profession as a whole. In addition, a nursing
association provides leadership in other areas such as
improving working conditions and benefits for nurses. A
nursing association also may lead the way in developing
public health policies.

 Describe the geographic distribution, academic credentials,
practice positions, and licensure status of members of the

board for your specific region/area.
Geographic distribution = Texas
 Academic credentials= APRN, RN, LVN, MSN, BA
 Practice positions = Family practice FNP, Instructor, Professor of a Vocational

Nursing Program, Consultant, Vice President of Nursing for Surgical/Procedural Services
for a Doctors Hospital, Quality Management, Interim Dean of Health and Human
Services/Director of Nursing for an associate degree nursing program, Director of
Public Policy, Quality Assurance hospital nurse, Lead faculty for a bachelor of science
program, Pediatric Nurse with Cook Children’s Medical, Vice President at First
Community Bank in Corpus Christi. A chairman of the Port Aransas Recreational
Development Corporation, and Licensed Vocational Nurse in the Primary Care
Outpatient Clinic at West Texas Veteran’s Health Administration.

Licensure status= As listed above and current in the state of Texas,
with the exception of the two BA’s on the board.

Distribution, Credentials, & Licensure
status

 Who is on the board?
 Kathy Shipp, President, APRN Practice, MSN, RN, FNP-Lubbock
 David Saucedo, II Vice President, Consumer member
 Nina Almasy, DNP, RN, CNE- Representing LVN Education
 Patricia “Patti” Clapp, BA-Consumer Member
 Laura Disque, MN, RN-Representing RN Practice
 Diana Flores, MN, RN-Representing RN Practice – Helotes
 Doris Jackson, DHA, MSN, RN, Representing ADN Education – Pearland
 Mazie Mathews Jamison, BA, MA, Consumer Member – Dallas
 Kathy Leader-Horn, LVN-Represents LVN Practice – Granbury
 Allison Porter-Edwards, DrPH, MS, RN, CNE-Representing BSN Education Bellaire
 Melissa Schat, LVN-Representing LVN Practice – Granbury
 Francis Stokes, BA, Consumer Member – Port Aransas
 Kimberly “Kim” Wright, LVN- Representing LVN Practice – Big Spring

The Board

 A person is not eligible for appointment as a public member of the board if the
person or the person’s spouse:
 (1) is registered, certified, or licensed by an occupational regulatory agency in the field of

health care;
 (2) is employed by or participates in the management of a business entity or other

organization that:
 (A) provides health care services;
 (B) sells, manufactures, or distributes health care supplies or equipment; or
 (C) is regulated by or receives money from the board;

 (3) owns or controls, directly or indirectly, more than a 10 percent interest in a business
entity or other organization that:
 (A) provides health care services;
 (B) sells, manufactures, or distributes health care supplies or equipment; or
 (C) is regulated by or receives money from the board; or

 (4) uses or receives a substantial amount of tangible goods, services, or funds from the
board, other than compensation or reimbursement authorized by law for board membership,
attendance, or expenses.

Becoming a Board Member

 One Federal Regulation for Healthcare is the; Readmissions reduction program.
 How does this regulation influence delivery, cost, and access to healthcare (e.g.,

CMS, OSHA, and EPA)?

 It’s the main goal of healthcare facilities to treat their patients and send them home
healthy. Readmissions occur when complications require a patient to return to the
hospital for further treatment. The readmissions reduction program was recently
established by the CMS “to encourage hospitals to manage their patients in a fashion
that reduces and/or eliminates readmissions to inpatient hospital care,” VanFleet says.

 The CMS gathers data from the program to reward hospitals with low readmissions
rates and penalize those with high readmissions rates. “The data allows CMS and
hospitals to tie outcomes to staffing,” says Young. That means you’ll be directly helping
your hospital and yourself if you pay careful attention to patient outcomes.

Federal Regulation

 Has there been any change to the regulation within the past 5 years?
Explain.

 Section 3025 of the Affordable Care Act requires the Secretary of the Department of Health
and Human Services (HHS) to establish HRRP and reduce payments to Inpatient Prospective
Payment System (IPPS) hospitals for excess readmissions beginning October 1, 2012

 CMS uses excess readmission ratios (ERR) to measure performance for each of the six
conditions/procedures in the program:

• Acute Myocardial Infarction (AMI)
• Chronic Obstructive Pulmonary Disease (COPD)
• Heart Failure (HF)
• Pneumonia
• Coronary Artery Bypass Graft (CABG) Surgery
• Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty.

Federal Regulation
continued

 In the FY 2014 IPPS final rule, CMS finalized the following policies:
 Adopted the application of an algorithm to account for planned readmissions to the

readmissions measures.
 Expanded the applicable conditions beginning with the FY 2015 program to include: (1) patients

admitted for an acute exacerbation of chronic obstructive pulmonary disease (COPD); and (2)
patients admitted for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).

 In the FY 2015 IPPS final rule, CMS finalized the following policies
 Expanded the applicable conditions beginning with the FY 2017 program to include patients

admitted for coronary artery bypass graft (CABG) surgery.

 In the FY 2016 IPPS final rule, CMS finalized the following policies:
 Adopted an extraordinary circumstance exception (ECE) policy allowing hospitals that

experience an extraordinary circumstance (such as a hurricane or flood) to request an exception.
 Refined the pneumonia readmission measure by expanding the measure cohort to include

additional pneumonia diagnoses: (i) patients with aspiration pneumonia; and (ii) sepsis patients
coded with pneumonia present on admission (but not including severe sepsis) beginning with
the FY 2017 program.

Federal Regulation
changes

 In the FY 2017 IPPS final rule, CMS finalized the following policy:
 Revised the date for publicly reporting hospitals’ excess readmission ratio on the

Hospital Compare website to allow for the posting of data as soon as possible
following the review period.

 In the FY 2018 IPPS final rule, CMS finalized the following policy:

 Changed the methodology to calculate the payment adjustment factor in
accordance with the 21st Century Cures Act to assess penalties based on a
hospital’s performance relative to other hospitals treating a similar proportion of
Medicare patients who are also eligible for full Medicaid benefits (i.e. dual eligible)
beginning with the FY 2019 program.

 Updated the ECE policy to allow facilities or hospitals to submit a form signed by
the facility or hospital’s CEO or designated personnel and to allow CMS to grant
ECEs due to CMS data system issues which affect data submission.

Federal Regulation
changes

 All licensed nurses practicing in Texas are required to “know and comply” with the Nursing
Practice Act (NPA) and Board Rules. 22 TAC §217.11(1)(B) requires the nurse to “promote a
safe environment for clients and others.” This standard establishes the nurse’s duty to the
patient/client, which supersedes any physician or any facility policy. This “duty” to
the patient requires the nurse to use informed professional judgment when choosing to
assist or engage in a given procedure.

 This regulation influences the nurse’s role in many ways. One way is that as nurses’, we are
always told to follow through with a physician’s . However, a professional nurse must
act as a prudent nurse. This means that if an is given for a medication, procedure,
etc. that the nurse may deem unsafe or cause harm to the patient, that nurse has the
obligation and duty to be the advocate for the patient and if need be, can refuse to
administer a medication or perform the procedure ed, despite what the physician
says or how they react.

 This regulation can influence the delivery, cost, and access to healthcare in so many ways.
If the nurse is in a situation in which they refuse to administer a medication that they
deem inappropriate for a patient could possibly avoid a patient going to the hospital,
which reduces the cost of healthcare, and provides the patient with a overall better
outcome. The delivery of care is affected in which one has to question why a prudent
nurse would have to question a physicians . A nurse takes an oath to provide care for
a patient by using their own professional judgement and this must always be followed to
the fullest extent to ensure quality outcomes.

State Regulation

 Prescription Monitoring Program (PMP)
 Board of Nursing, 222.8. Authority to Order and Prescribe Controlled Substances (ADOPTED 11/9/18)

This rule was amended by the BON to implement Prescription Monitoring Program rules, as required by
legislation from the 85th Session. The rules state that an APRN must check the PMP, and document that
check, prior to prescribing opioids, benzodiazepines, barbiturates, or carisoprodol, unless the patient is
receiving hospice care or is diagnosed with cancer. An APRN is not subject to discipline if the APRN
makes a good faith attempt to review the PMP but is unable to, and documents that attempt. The APRN
Alliance submitted comments, arguing that the BON should not discipline for failing to document, that
they should clarify the meaning of a “prescription record,” as used in the amendment, and that they
should include an effective date, which by law is September 1, 2019. In its adoption, the BON provided
clarifications on the second point and accepted the third.

 As a RN moving into an APRN role, this completely changes their scope of practice. Of course RN’s do
not having prescribing medication abilities. Also, with so much focus on the opioid epidemic right now,
APRN’s must be very diligent in ensuring they have met the proper guidelines prior to prescribing
medications.

 This regulation influences delivery, cost and access to healthcare in so many ways. Having APRNs with
the ability to prescribe medications and treat patients is a game changer in healthcare itself. This can
and has shown to significantly lower the cost of healthcare as opposed to patients being restricted to
only being seen by a physician, especially in rural areas. On the other hand, there must still be policies in
place to ensure that APRN’s are followed closely by a physician. Physicians in Texas are still required to
sign off on all APRN’s treatment s. This is a safety issue as physicians have more extensive training
than APRN’s

State Regulations for APRN

 American Nurses Association [ANA]. (2010). Nursing Professional Development: Scope
and Standards of Practice. Silver Spring, Maryland: Nurses Books.org.

 About U.S. Boards of Nursing. (n.d.). Retrieved July 03, 2019, from
https://www.ncsbn.org/

 The American Association of Nurse Practitioners. (2017). State advocacy. Retrieved from
https://www.aanp.org/advocacy/state/state-practice-environment

 Texas Board of Nursing (n. d.). Nurse practice act. Retrieved July 2, 2019, from https://
www.bon.texas.gov/laws_and_rules_nursing_practice_act.asp

 About U.S. Boards of Nursing. (n.d.). Retrieved July 5, 2019, from National Council of
State Boards of Nursing: https://www.ncsbn.org/about-boards-of-nursing.htm

 Readmissions-Reduction-Program. (2019, January 16). Retrieved from https://
www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissio
ns-reduction-program.html

 Hospital Readmissions. (n.d.). Retrieved from

Hospital Readmissions

References

https://www.aanp.org/advocacy/state/state-practice-environment

https://www.bon.texas.gov/laws_and_rules_nursing_practice_act.asp

https://www.ncsbn.org/about-boards-of-nursing.htm

https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html

Hospital Readmissions

Regulation for Nursing Practice Staff Development Meeting
Objectives
Slide 3
Distribution, Credentials, & Licensure status
The Board
Becoming a Board Member
Federal Regulation
Federal Regulation continued
Federal Regulation changes
Federal Regulation changes
State Regulation
State Regulations for APRN
References

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